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Plans & Rates

BENEFIT		ADVANTAGE PLAN	CHOICE PLAN	COMPLETE PLAN
Inpatient Care	First Hospital Admission	Up to $5,000	Up to $5,000	Up to $5,000
	Daily Hospital Benefit	Up to $29,200 $80 per day	Up to $36,500 $100 per day	Up to $73,000 $200 per day
	Surgical Benefit (see Schedule)	Up to $1,000 per covered surgery	Up to $2,500 per covered surgery	Up to $5,000 per covered surgery
	Hospital Injury Indemnity	N/A	$100 per day	$100 per day
	Anesthesia Benefit	Up to $250	Up to $625	Up to $1,250
	Intensive Care Benefit	Up to $3,000 $150 per day	Up to $5,000 $250 per day	Up to $20,000 $1,000 per day
	Private Duty Nurse	$100 per day	$100 per day	$100 per day
Outpatient Care	Office Visits	Up to $25	Up to $50	Up to $75
	Emergency Accident	Up to $100	Up to $150	Up to $200
Wellness Care	Mammography Screening	N/A	N/A	Up to $200
	Papanicolaou Testing (Pap Smear)	N/A	N/A	Up to $50
	PSA Testing	N/A	N/A	Up to $100
	Diagnostic Lab Testing	Included	Included	Included
Accident Benefits	Medical Accident Plan	Up to $1,000 per occurrence	Up to $2,000 per occurrence	Up to $5,000 per occurrence
Prescription Benefits	AmeriScript Rx Card*	$10/$20/$40 Tiers 1-3 Discounts Tier 4	$10/$20/$40 Tiers 1-3 Discounts Tier 4	$10/$20/$40 Tiers 1-3 Discounts Tier 4
HealthCare Benefits	PPO Network	Included	Included	Included
	Dental	Discounts	Discounts	Discounts
	Vision	Discounts	Discounts	Discounts
	Chiropractic	Discounts	Discounts	Discounts
	Pre-Paid Legal	Discounts	Discounts	Discounts
AD&D Benefits	Member	$10,000	$25,000	$50,000
	Spouse	$10,000	$15,000	$25,000
	Children	$5,000	$5,000	$5,000